JP7562547B2 - Threaded targeting instruments, systems, and methods of use - Google Patents

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims the benefit of priority under 35 U.S.C. §119(e) to U.S. Provisional Application No. 62/805,777, entitled "Threaded Targeting Devices, Systems, and Methods of Use," filed February 14, 2019, the contents of which are incorporated by reference in their entirety herein.

The present invention relates generally to general surgical, podiatric, and orthopedic devices used to correct foot deformities. More specifically, but not by way of limitation, the present invention relates to devices, implants, plates, systems, and methods for correcting bone deformities.

Many of the commercially available devices used in conjunction with implants to correct bone deformities and fractures use a variety of alignment mechanisms. Current commercially available devices suffer from insufficient surgical exposure, inconsistent alignment, imprecise targeting, and instability. Therefore, new devices and methods of use are needed to properly and reproducibly orthotic and stabilizing devices implanted in the foot and ankle.

Aspects of the present invention provide devices, implants, plates, systems, and methods for correcting bone deformities in the foot.

In one aspect of the present invention, a targeting guide is provided herein. The targeting guide includes a guide arm, a guide tube coupled to the guide arm, and a guide pin movably engaged to an end of the guide arm.

In another aspect, a method of using a target guide to fix two bones together is provided herein. The method includes inserting a guide pin into the bone and fixing an implant holder to the bone plate. The method includes fixing a guide arm to the guide pin at a second end of the guide arm and fixing an intermediate portion of the guide arm in a channel of the implant holder. The method also includes inserting a guide tube into the first end of the guide arm and inserting a drill guide through the through hole of the guide tube. Next, the method includes inserting a protective member through the through hole of the drill guide and inserting a target pin through the protective member and into at least one bone. The method includes inserting two fixation wires through two protrusions disposed on a housing element disposed on the second end of the guide arm and removing the guide pin from the guide arm. The method includes inserting a target pin into the talus bone generally through the first metatarsal bone extending proximally and removing the protective member from the drill guide. The method includes rotating the guide tube to perform a reduction of the joint and drilling a hole over the target pin. The method further includes screwing an implant through the drill guide into the bone to fixate the at least two bones.

These and other objects, features, and advantages of the present invention will become apparent from the following detailed description of the various aspects of the invention taken in conjunction with the accompanying drawings.

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the present invention and, together with the detailed description herein, serve to explain the principles of the present invention. The drawings are used only for the purpose of illustrating preferred embodiments and are not to be construed as limiting the present invention. In accordance with standard industry practice, various features are not shown to scale. In fact, dimensions of various features may be arbitrarily increased or decreased for clarity of discussion. The above and other objects, features, and advantages of the present invention will become apparent from the following detailed description of various aspects of the present invention taken in conjunction with the accompanying drawings.

1 is a first side perspective view of one embodiment of a targeting guide in accordance with an aspect of the present invention; 2 is a second side perspective view of the targeting guide of FIG. 1 according to one aspect of the present invention. 2 is a bottom view of the targeting guide of FIG. 1 according to one embodiment of the present invention. 2 is a top view of the targeting guide of FIG. 1 in accordance with one embodiment of the present invention. 2 is a first end view of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 2 is a second end view of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 2 is a first side view of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 2 is a second side view of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 2 is an exploded first perspective view of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 2 is an exploded second perspective view of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 2 is an exploded bottom view of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 2 is an exploded top view of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 2 is a first perspective view of the targeting guide of FIG. 1 having a bone plate attached thereto, in accordance with one aspect of the present invention. FIG. 13 is a second perspective view of the targeting guide and bone plate according to one aspect of the present invention. 2 is a first perspective view of a guide arm of the targeting guide of FIG. 1 according to one aspect of the present invention. 16 is a second perspective view of the guide arm of FIG. 15 according to an aspect of the present invention. 16 is a bottom view of the guide arm of FIG. 15 in accordance with one aspect of the present invention. 16 is a top view of the guide arm of FIG. 15 in accordance with an aspect of the present invention. 16 is a first end view of the guide arm of FIG. 15 according to one aspect of the present invention. 16 is a second end view of the guide arm of FIG. 15 in accordance with an aspect of the present invention. 16 is a first side view of the guide arm of FIG. 15 according to one aspect of the present invention. 16 is a second side view of the guide arm of FIG. 15 according to an aspect of the present invention. 16 is a close-up view of a second end of the guide arm of FIG. 15 in accordance with one aspect of the present invention. 2 is a first perspective view of a protective member of the targeting guide of FIG. 1 according to one aspect of the present invention. 25 is a second perspective view of the protective member of FIG. 24 according to an aspect of the present invention. 25 is a side view of the protective member of FIG. 24 in accordance with one aspect of the present invention. 25 is a first end view of the protective member of FIG. 24 in accordance with one aspect of the present invention. 28 is a cross-sectional view of the protective member of FIG. 24 taken along line 28-28 of FIG. 27, in accordance with an aspect of the present invention. 2 is a first perspective view of a drill guide of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. FIG. 30 is a second perspective view of the drill guide of FIG. 29 in accordance with an aspect of the present invention. 30 is a side view of the drill guide of FIG. 29 in accordance with an aspect of the present invention. 30 is an end view of the drill guide of FIG. 29 in accordance with an aspect of the present invention. 33 is a cross-sectional view of the drill guide of FIG. 29 taken along line 33-33 of FIG. 32, in accordance with an aspect of the present invention. 2 is a first perspective view of a reduction guide tube, reduction cap, and rotation tool of the targeting guide of FIG. 1 in accordance with one aspect of the present invention. 35 is a second perspective view of the reduction guide tube and reduction cap of FIG. 34 according to an embodiment of the present invention. 35 is a top view of the reduction guide tube and reduction cap of FIG. 34 in accordance with an embodiment of the present invention. 35 is a first end view of the reduction guide tube and reduction cap of FIG. 34 in accordance with an aspect of the present invention. 35 is a second end view of the reduction guide tube and reduction cap of FIG. 34 in accordance with an aspect of the present invention. 39 is a cross-sectional view of the assembled reduction guide tube and reduction cap of FIG. 34 taken along line 39-39 of FIG. 5, in accordance with one aspect of the present invention. 38 is a cross-sectional view of the exploded reduction guide tube and reduction cap of FIG. 34 taken along line 40-40 of FIG. 38, in accordance with one aspect of the present invention. 14 is a first perspective view of the bone plate of FIG. 13 according to one aspect of the present invention. 42 is a second perspective view of the bone plate of FIG. 41 according to one aspect of the present invention. 2 is a dorsal perspective view of a portion of a foot having a guide pin of the targeting guide of FIG. 1 inserted into the foot, according to one aspect of the present invention. 44 is a dorsal perspective view of the foot of FIG. 43 having the implant holder of the targeting guide of FIG. 1 coupled to the bone plate and the bone plate of FIG. 41 positioned on the foot, according to one aspect of the present invention. 45 is a medial view of the foot of FIG. 44 with the guide arm of FIG. 15 coupled to an implant holder and guide pin, according to one aspect of the present invention. FIG. 46 is a rear perspective view of FIG. 45 according to one aspect of the present invention. 46 with the reduced guide tube of FIG. 34 inserted into the guide arm, the drill guide of FIG. 29 inserted into the reduced guide tube, and the protective member of FIG. 24 inserted into the drill guide, according to one aspect of the present invention. 48 is a medial view of the foot of FIG. 47 with a targeting pin inserted into the foot through the protective member, two fixation wires inserted into the foot through the guide arm, and an olive wire inserted into the foot through the bone plate, according to one embodiment of the present invention. FIG. 49 is a dorsal perspective view of the foot of FIG. 48 according to one aspect of the present invention. FIG. 50 is a close-up view of the proximal end of the guide arm on the foot of FIG. 49 according to one aspect of the present invention. 50 is a plantar view of the foot of FIG. 49 in accordance with one aspect of the present invention. FIG. 50 is an enlarged perspective view of the sole of the portion of the foot of FIG. 49 with a transparent bone, according to one embodiment of the present invention. 50 is a plantar view of the foot of FIG. 49 with the reduction cap coupled to the reduction guide tube and the protective member removed, according to one aspect of the present invention. 54 is a perspective view of the plantar surface of the foot of FIG. 53 according to one aspect of the present invention. 55 is a perspective view of the plantar surface of the foot of FIG. 54 after removal of the drill guide, insertion of a threaded member, and removal of the targeting pin, according to one aspect of the present invention. 56 is a medial view of the foot of FIG. 55, according to one aspect of the present invention. A medial view of the foot of FIG. 56 after bone fasteners have been inserted through the bone plate into the foot and the fixation wires, olive wires, guide arms, reduction guide tubes, reduction caps, implant holders, and guide pins have been removed, according to one aspect of the present invention. 58 is a distal perspective view of the foot of FIG. 57 according to one aspect of the present invention.

Generally, devices, implants, plates, and systems for correcting bone deformities are described and disclosed herein. Methods for correcting bone defects using the devices, implants, plates, and systems are also described.

In this detailed description and in the claims that follow, the terms proximal, distal, anterior or plantar, posterior, dorsal, medial, lateral, superior, and inferior are defined by their standard usage to refer to specific sites or portions of a bone or implant according to terms that indicate the relative placement or orientation of references in natural bone. For example, "proximal" refers to the portion of the device or implant closest to the torso, while "distal" refers to the portion of the device or implant furthest from the torso. As directional terms, "anterior" is toward the front of the body, "posterior" is toward the back of the body, "medial" is toward the midline of the body, "lateral" is toward the side or away from the midline of the body, "superior" is toward the top of another object or structure, and "inferior" is toward the bottom of another object or structure. Additionally, with respect to the foot specifically, the term "dorsal" refers to the top of the foot and the term "plantar" refers to the bottom of the foot.

Similarly, location or orientation is used herein with reference to an anatomical structure or surface. For example, as the instruments and methods are described herein with reference to use on the bones of the foot, the bones of the foot, ankle, and lower leg may be used to describe the surface, location, direction, or orientation of the instruments and methods. Additionally, the instruments and methods, and aspects, components, features, etc. disclosed herein are described with respect to one side of the body for brevity. However, because the human body is relatively symmetrical or mirror imaged about a line of symmetry (the midline), it is expressly intended that the instruments and methods, and aspects, components, features, etc. described and/or illustrated herein may be altered, changed, modified, reconfigured, or otherwise modified for use on or in association with the opposite side of the body for the same or similar purposes without departing from the spirit and scope of the present invention. For example, the instruments and methods, and aspects, components, features, etc. described herein with respect to the right foot may be inverted to function on the left foot as well. Additionally, although the devices and methods, and aspects, components, features, etc. described herein are described with respect to the foot for brevity, it should be understood that the devices and methods may be used with other bones of the body having similar structures.

1 to 42, a targeting guide assembly 100 is shown. The targeting guide assembly 100 includes a guide arm 110, a target assembly 150, an implant holder 260, a guide pin 290, and fixing wires 300 and 310. As shown in FIGS. 11 and 12, the target assembly 150 may include a guide pin 152, a protective member 160, a drill guide 180, and a reduced guide tube 200, and may optionally include a reduced cap 220. The reduced guide tube 200 is received in a through hole 122 provided at a first end 114 of the guide arm 110. The implant holder 260 is movably engaged with the guide arm 110 and may slide along the body 112 of the guide arm 110 to allow for position adjustment of the coupled bone plate 320, as shown in, for example, FIGS. 45 to 47. The guide pin 290 is rotatably coupled to the second end 116 of the guide arm 110, and the fixing wires 300, 310 are received in holes 142, 146 provided near the second end 116 of the guide arm 110.

15-23, the guide arm 110 includes a body or elongated body 112 connecting a first end 114 and a second end 116. The first end 114 may include a wide portion 120, for example, including a side surface on a circular arc, and the wide portion 120 may be attached in a generally perpendicular direction to the body 112. The wide portion 120 may include a connecting portion 121 having a through hole 122 having a size or shape to receive the reduced guide tube 200. The through hole 122 may be larger or smaller than that shown in FIGS. 15-23. The through hole 122 may be threaded along at least a portion of the through hole 122, for example. The through hole 122 may have a size corresponding to the size of the threaded portion 202 of the reduced guide tube 200, for example. The through hole 122 may extend parallel to the body 112 along the wide portion 120, such that the target assembly 150 extends parallel to the body 112 of the guide arm 110.

15-23, the second end 116 may include, for example, a sloped portion 118. The sloped portion 118 extends from the body 112 in a downwardly sloping direction toward the second end 116. The housing element 124 may be disposed at the second end 116 and may be configured or sized and shaped to receive a guide pin 290. The housing element 124 may include a first arm portion 130 and a second arm portion 132 separated by a channel 136. The channel 136 may extend from an exterior surface of the housing element 124 into the housing element 124 and into the sloped portion 118. The housing element 124 includes a top opening 126 and a bottom opening 128, which form an inner surface or interior cavity 134 extending between the top opening 126 and the bottom opening 128. The interior cavity 134 may intersect the channel 136. The interior surface 134 may be configured or sized or shaped to allow the guide pin 290 to pivot, rotate, or move in multiple planes, as shown, for example, in Figures 6-8, 15-16, and 21-23. The top opening 126 may be sized to allow insertion of the ball 294 of the guide pin 290 into the housing element 124. The bottom opening 128 may be slightly smaller than the top opening 126, for example, to capture or retain the guide pin 290 within the interior cavity 134 of the housing element 124. The housing element 124 may include a first protrusion (or ear) 140 and a second protrusion (or ear) 144, as shown, for example, in Figures 15, 16, and 20-23. The first protrusion 140 may extend from the first arm 130 on a side opposite the channel 136, and the second protrusion 144 may extend from the second arm 132 on a side opposite the channel 136. The first protrusion 140 may include a through hole 142. The through hole 142 may extend, for example, obliquely through the first arm 130. The second protrusion 144 may include a through hole 146, which may extend, for example, obliquely through the second arm 132. The trajectories of the first and second through holes 142 and 146 may be arranged, for example, such that guide wires inserted into the through holes 142 and 146 converge without crossing.

Continuing with reference to the target assembly 150 of FIGS. 11 and 12, the guide pin or target pin 152 may have a first end (or first tip) 154 that is inserted into the patient and a second end 156 opposite the first end 154. The guide pin 152 may be an elongated pin-like structure or member, such as a guide wire, k-wire, pin, or the like, for insertion through a joint. In the illustrated embodiment, the guide pin 152 has a smooth outer surface with a point or sharp portion 154 at one end. As shown in FIGS. 48-49, the guide pin 152, when positioned or inserted into, for example, the bone passage, is inserted in a distal to proximal direction through a cannulated opening or through hole 176 in the protective member 160 to allow the targeting guide to be secured to the surgical site and to establish a target location proximally.

9-12 and 24-28, the protective member 160 may include a knob or head 162 disposed on a first end of a tubular portion, body portion, or shaft 168. The head 162 may include an engagement portion 164 and a stop portion 166. The engagement portion 164 may engage a recessed region of the drill guide tube 180 when inserted into the drill guide tube 180. The stop portion 166 may contact a distal end of the drill guide tube 180 when inserted into the drill guide tube 180. The protective member 160 may include a tip 172 that contacts the patient's bone. The tip 172 may include engagement teeth or ridges 174, for example, to aid in engagement with the patient's bone. The protective member 160 may further include a through hole or cannulated opening 176 extending through the protective member 160 along a longitudinal axis of the protective member 160. The body portion 168 of the protective member 160 may include a number of apertures 170 disposed along the length of the protective member 160. The apertures 170 may extend from an exterior surface of the body portion 168 into a through hole 176. The protective member 160 may protect the surrounding soft tissue, for example, when the target pin 152 is inserted through the protective member 160 and into the patient's bone. As shown in Figures 1-4, 7-8, 13-14, 47-49, 51, and 52, the tip 172 of the protective member 160 may extend past the tip 188 of the drill guide 180 and the proximal end of the guide tube 200. The location of the tip 172 of the protective member 160 relative to the proximal end of the drill guide 180 and the guide tube 200 enhances visibility of the anatomical location and improves the anatomical track on the surface of the bone.

9-12 and 29-33, the drill guide tube or drill guide 180 may include a cylindrical portion, body, or shaft 182 and a knob or head 186 disposed at a first end of the cylindrical portion 182. The drill guide 180 may include a tip 188 disposed at a second end of the cylindrical portion 182. The cylindrical portion 182 of the drill guide 180 may have a larger diameter than the cylindrical portion 168 of the protective member 160, for example. The drill guide 180 may include a through hole or cannulated opening 190 extending along a longitudinal axis of the drill guide 180. The drill guide 180 may include a plurality of openings 184 disposed along a length of the cylindrical portion 182. The openings 184 may extend from an exterior surface of the body portion 182 into the through hole 190. The drill guide 180 may protect the surrounding soft tissue when a drill is inserted through the cannulated opening 190, for example, to open an opening for inserting the threaded member 240.

9-12, 34-36, 39, and 40, the reduced guide tube 200 includes a threaded portion 202, a body 204 extending away from a first or distal end of the threaded portion 202, and a head 208 coupled to a second or proximal end of the threaded portion 202. The guide tube 200 may include a through hole 216 extending through the head 208, the threaded portion 202, and the body 204 along a longitudinal axis of the guide tube 200. The body 204 may include a plurality of openings 206, for example, disposed along the length of the body 204 and extending from an exterior surface of the body 204 into the through hole 216. The body 204 may include a lip or protrusion 214 disposed near the first end and extending from an exterior surface of the body 204. The lip 214 may circumferentially surround the body 204. The head 208 may include a notch or recess 210 disposed about an exterior surface of the head 208. The notch 210 may be generally perpendicular to the through hole 216. The notch 210 may be sized and shaped to receive, for example, an engagement tab or protrusion 219 of a tool, instrument, handle, and hooked spanner 218. The tool 218 may be used to rotate the guide tube 200 and translate the guide tube 200 relative to the through hole 122 of the guide arm 110. The head 208 may include a recessed opening 212 extending into the guide tube 200 from the second end toward the first end. The recessed opening 212 may be disposed around or surrounding the through hole 216, for example. The recessed opening 212 may be sized and shaped to receive, for example, the knob 186 of the drill guide 180. The body 204 may have a first diameter, the threaded portion 202 may have a second diameter, and the head 208 may have a third diameter. As shown, the second diameter may be, for example, larger than the first diameter, and the third diameter may be, for example, larger than the first and second diameters.

Continuing with reference to FIGS. 9-12, 34-36, and 39, the reduction or compression cap 220 may include a base 222 and a number of tabs or projections 224 extending away from a first or proximal end of the base 222. The reduction cap may include a through hole 228 extending along a longitudinal axis of the reduction cap 220 through the base 222 and between the number of tabs 224. Each of the number of tabs 224 may include teeth 230 extending from an inner surface of the tab 224 into the through hole 228. The number of teeth 230 may be sized and shaped to engage, for example, the lip 214 of the guide tube 200. The number of tabs 224 may be separated by a number of grooves 226 extending from the proximal end of the reduction cap 220 toward the base 222. The reduction cap 220 may have a slot (not shown), for example, extending from a first or proximal end of the reduction cap 220 to a second or distal end of the reduction cap 220 and extending from an exterior surface of the reduction cap 220 into the through hole 216. The slot (not shown) allows the reduction cap 220 to be removed from the targeting guide 100 while the targeting pin 152 is inserted into the patient's foot.

As shown in FIGS. 1-4 and 7-14, the threaded member or implant 240 may include a head portion 242 and a shaft 246. The head portion 242 may be disposed at a first end of the shaft 246, and a cutting flute or distal cutting flute 248 may be disposed at a second end of the shaft 246. The threaded member 240 may include a proximal cutting flute 244 disposed at the head portion 242. The cutting flutes 244, 248 may facilitate insertion of the threaded member 240 into the bone. The threaded member 240 may also include a through hole or cannulated opening 250 extending along a longitudinal axis through the threaded member 240. The through hole 250 may be configured to receive a target pin 152 and may be sized and shaped to receive the target pin 152. Alternatively, the threaded member 240 may be solid, for example, without a longitudinal opening. As shown, the threaded member 240 is threaded along its entire length, however, it is contemplated that the threaded member 240 may be threaded only along a portion, e.g., having partial or segmented threads along its length.

The implant holder 260 may include a housing 262, a knob 274, and a locking member 280. The housing 262 may include an attachment arm 264 extending from the housing 262 and parallel thereto to form, for example, a U-shaped or hook-like structure. The attachment arm 264 may hook onto the bottom of the body 112 of the guide arm 110 and slide along the longitudinal axis of the body 112. A channel 266 is formed between the attachment arm 264 and the housing 262 and may be configured to receive the body 112 of the guide arm 110 and may be sized and shaped to receive the body 112 of the guide arm 110. The attachment arm 264 may have at least one hole 268 extending from an exterior surface through the attachment arm 264 and into the channel 266. The at least one hole 268 may be, for example, one to four holes, and more specifically, may be three holes. The implant holder 260 may include an alignment post 270 extending away from a bottom surface of the housing 262. The implant holder 260 may further include a through hole 262 extending through the housing 262 from a top surface to a bottom surface adjacent the alignment post 270. The knob 274 may include an engagement protrusion 276 extending away from a rear surface of the knob 274. The engagement protrusion 276 may be, for example, threaded to engage at least one hole 268 in the mounting arm 264 to secure the implant holder 260 to the body 112 of the guide arm 110 in a desired position. The locking member 280 may include a shaft 282 having a knob 284 on a first end and a threaded portion 286 on a second end. The shaft 282 may be inserted through the through hole 272 of the housing 262 until the knob 284 contacts the top surface of the housing 262 and the threaded portion 286 extends past the bottom surface of the housing 262. The threaded portion 286 may engage a bone plate, such as bone plate 320, as described in more detail below. The knob 284 may be rotated to insert the threaded portion 286 into the bone plate 320 and to remove the threaded portion 286 from the bone plate 320.

1-4 and 6-14, the guide pin 290 may include a shaft 292, a sphere 294, a tip 296, and a cylindrical projection 298. The sphere or spherical member 294 may be disposed between the first end and the tip 296. The tip 296 may be threaded, but it is contemplated that the tip 296 may have a smooth outer surface to facilitate insertion. The tip 296 may be configured or sized and shaped to allow a user to insert the guide pin 290 directly into a target bone or through the skin. Once inserted into the target bone, the guide pin 290 may be secured to establish a target location for the threaded member 240. As shown in FIGS. 1-4, 6, 50, and 52, the sphere 294 may be sized and shaped or configured to be inserted into the housing element 124 to allow a full range of rotational movement. The cylindrical portion 298 may be disposed adjacent to the sphere 294, and more specifically, may be disposed between the sphere 294 and the tip 296.

As shown in Figures 1 to 14, the targeting guide 100 may include a first fixation wire 300 and a second fixation wire 310. The first fixation wire 300 includes a first end 302 and a second end or tip 304 disposed opposite the first end 302. The second fixation wire 310 includes a first end 312 and a second end or tip 314 disposed opposite the first end 312. The fixation wires 300, 310 may be inserted into the patient's foot through the through holes 142, 146 of the first prong 140 and the second prong 144.

13-14 and 41-42, a bone plate 320 is illustrated. The bone plate 320 includes a first or proximal end 322 opposite a second or distal end 324 and a top or outer surface 326 opposite a bottom or bone-contacting surface 328. The bone plate 320 may include a locking member aperture 330 disposed near the second end 324. The locking member aperture 330 receives the threaded portion 286 of the locking member 280 to secure the bone plate 320 to the implant holder 260. The bone plate 320 may include a proximal channel or aperture 332 disposed near the first end 322 and an intermediate channel or aperture 334 disposed near a midpoint of the bone plate 320. The bone plate 320 further includes a plurality of lobes 336 disposed on both sides and both ends of the bone plate 320. Each lobe 336 of the plurality of lobes 336 may include an aperture or bone screw aperture 338. The bone screw aperture 338 receives a bone fastener or bone screw to secure the bone plate 320 to the patient's bone.

The targeting guide assembly 100 may be assembled by inserting the guide pin 290 into the housing element 124 of the guide arm 110. Alternatively, the housing element 124 of the guide arm 110 may be inserted into the guide pin 290. The reduced guide tube 200 may be inserted into the through hole 122 of the guide arm 110. The drill guide 180 may then be inserted into the through hole 216 of the guide tube 200. The protective member 160 may then be inserted into the through hole 190 of the drill guide 180 to receive the target pin 152. Alternatively, the protective member 160 may be inserted into the drill guide 180, and the combined protective member 160 and drill guide 180 may be placed into the reduced guide tube 200. Additionally, the implant holder 260 may be aligned with the body 112 of the guide arm 110 and secured in a desired position by engaging the engagement protrusion 276 of the knob 274 with the body of the guide arm 110. The locking member 280 may be inserted into the opening 272 of the housing 262. The alignment post 270 may then be aligned with a corresponding alignment opening (not shown) in the bone plate 320, and the threaded portion 286 of the locking member 280 may engage with the corresponding threaded opening 330 of the bone plate 320.

43-58, a method of using the targeting guide assembly 100 to correct a bone deformity is shown. The method may include, for example, performing arthrodesis across at least one joint. At least two bones of the at least one joint may be positioned in a desired final position or may be temporarily fixed. As shown in FIG. 43, the method may include inserting a guide pin 290 into a first bone 342 and setting a trajectory for the guide pin 152 and the threaded member 240. The first bone 342 may be, for example, the talus, and specifically, the neck of the talus. Next, as shown in FIG. 44, a bone plate 320 may be selected and the locking member 280 may be used to couple the implant holder 260 to the locking member opening 330. The knob 274 may be coupled to the mounting arm 264 of the implant holder 260 before or after the implant holder 260 is coupled to the bone plate 320. Thereafter, as shown in FIGS. 45-46 , the housing element 124 of the guide arm 110 may be coupled to the ball 294 of the guide pin 290. The guide arm 110 may be rotated about the ball 294 to position the first end 114 of the guide arm 110 against a second bone 344, which may be, for example, a first metatarsal. While the guide arm 110 is rotated on the ball 294, the guide arm 110 may be inserted into the channel 266 of the implant holder 260 to position the bone plate 320 and a distal portion of the guide arm 110 on the head of the second bone 344. Once the bone plate 320 is coupled to the implant holder 260, the position of the bone plate 320 may be adjusted along the length of the guide arm 110 to allow for positioning of the bone plate 320 in a first plane, for example, the sagittal plane. Alternatively or in addition to adjusting along its length, the guide arm 110 may be rotated about the guide pin 290 to rotate the bone plate 320 in a second plane, e.g., the coronal plane. Movement of the bone plate 320 in two planes allows the insertion of fixation devices or bone screws 352 in a trajectory that avoids contact with the target pins 152 and/or threaded members 240. After achieving the desired position or trajectory, the knob 274 of the implant holder 260 may be tightened to secure the guide arm 110 to the implant holder 260.

47, the reduced guide tube 200, drill guide 180, and protective member 160 of the target assembly 150 may be positioned to position the starting point of the target pin or beaming screw guide wire 152. For example, the reduced guide tube 200 may be inserted into the through hole 122 of the guide arm 110 by engaging the threaded portion 202 of the guide tube 200 with the threads extending into the through hole 122. The drill guide 180 may then be inserted into the through hole 216 of the guide tube 200 until the knob 186 of the drill guide 180 is located in the recessed opening 212 of the guide tube 200. The protective member 160 may then be inserted into the through hole 190 of the drill guide 180. The target pin 152 may then be inserted into at least one bone 342, 344, 346, 348 through the through hole 176 of the protective member 160, as shown in FIGS. 48-49. The target pin 152 may be inserted, for example, from the metatarsal head 344 first. The trajectory of the target pin 152 overlaps, crosses, or engages with the guide pin 290. In one embodiment, the implant holder 260 may be coupled to the guide arm 110 before the guide arm 110 is coupled to the guide pin 290. Alternatively, the implant holder 260 may be coupled to the guide arm 110 after the target pin 152 is inserted into the bone 342, 344, 346, 348. In an alternative embodiment, the bone plate 320 may be coupled to the implant holder 260 and aligned on the bone 342, 344, 346, 348.

After the target pin 152 is placed in the desired location and confirmed under fluoroscopy, two fixation wires or k-wires 300, 310 may be inserted into the first bone 342, as shown in FIGS. 48-50. Alternatively, the fixation wires 300, 310 may be inserted after initial placement of the guide wire 152 in the metatarsal bone and prior to reduction of the joint. For additional stability, the wires 300, 310 may be inserted into the first bone 342 through the through holes 142, 146 in the prongs 140, 144 of the guide arm 110. As shown in FIGS. 48-52, an olive wire 350 may be inserted into a third bone 346, such as the medial cuneiform bone, through an opening 338 in the bone plate 320 to secure the bone plate 320 to the foot 340. The guide pin 290 may then be removed from the first bone 344 and the housing element 124 of the guide arm 110, as shown in FIGS. 51-52. Once the guide pin 290 is removed, the target pin 152 may be advanced through the entire first metatarsal 344, the medial cuneiform 346, and the navicular 348 into the talus or talar body 342, as shown in FIGS. 51-52. The guide pin 290 may be inserted over the fixation wires 300, 310 so that the track of the guide pin 290 extends between the two fixation wires 300, 310.

53-54, after the guide pins 290 are inserted through the bones 342, 344, 346, 348, the protective member 160 may be removed from the drill guide 180. The protective member 160 may be removed by sliding the protective member 160 over the target pins 152 through the through holes 190 of the guide arm 180. A compression cap 220 may then be selectively coupled to the proximal end of the reduction guide tube 200. Although not shown, the compression cap 220 may include a slit that allows the compression cap 220 to be placed on the guide tube 200 with the target pins 152 extending through the through holes 216 of the guide tube 200. After removing the protective member 160, the joint reduction may be performed by rotating the head of the reduction guide tube 200, for example, clockwise, with or without the compression cap 220 coupled thereto. If additional torque is required to effect reduction, the tool 218 may be used to rotate the head portion 208 by inserting the engagement tab of the tool 218 into the notch 210 in the head 208 of the tool 218, as shown in FIG. 54.

A cannulated drill may be selectively used to drill holes through the drill guide 180 onto the target pin 152. A countersink may be selectively drilled through the drill guide 180. The cannulated drill and drill guide 180 may then be removed from the reduced guide tube 200. The threaded member 240 may then be inserted through the guide tube 200 over the target pin 150 and into the bone 342, 344, 346, 348 as shown in FIGS. 55-56. At least one olive wire 350, more preferably at least two olive wires 350, may then be placed into the channels 332, 334 of the bone plate 320 to maintain the position of the bone plate 320. The olive wires 350 inserted into the channels 332, 334 allow the surgeon to slide the bone plate 320 in a proximal-distal direction for proper placement. Next, as shown in Figs. 57-58, the reduced guide tube 200, the fixation wires 300, 310, the guide arm 110, the implant holder 260, and the target pins 152 may be removed from the foot 340 and the surgical area. Finally, as shown in Figs. 57-58, the bone plate 320 may be secured to the bones 342, 344, 346, 348 using bone fasteners or bone screws 352 that are inserted so as not to contact the threaded member 240 during insertion. The bone fasteners, bone screws, or fasteners 352 may be, for example, locking or non-locking fasteners. Although not shown, it is also contemplated that the bone plate 320 may be coupled to the bones 342, 344, 346, 348 before the threaded member 240 is inserted into the bones 342, 344, 346, 348.

As will be appreciated by those skilled in the art based on the teachings herein, numerous changes and modifications can be made to the above-described and other embodiments of the present disclosure without departing from the scope of the present disclosure. The components of the instruments, guides, implants, plates, and/or systems disclosed in the specification, including the accompanying abstract and drawings, may be replaced with alternative components or features as disclosed in another embodiment, which provide the same, equivalent, or similar results as known to those skilled in the art, to provide the same functionality for the intended purpose. Also, the instruments, guides, implants, plates, and/or systems may have more or fewer components or features than the embodiments described and illustrated herein. For example, the components and features of Figures 1 to 58 of the present application and the components and features of Figures 1 to 31 of WO 2018/157170, which are incorporated herein by reference in their entirety, may be used interchangeably in alternative combinations as modified or substituted by those skilled in the art. Additionally, the steps of the surgical method associated with Figures 1 to 58 of the present application and the steps of the surgical method associated with Figures 1 to 31 of WO 2018/157170 may be used interchangeably in alternative combinations as modified or substituted by those skilled in the art. Accordingly, this detailed description of the currently preferred embodiment should be taken as illustrative and not limiting of the present disclosure.

The terms used herein are used only for the purpose of describing particular embodiments and are not intended to limit the invention. As used herein, the singular forms "a", "an", and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. The terms "comprise" (and other forms of comprise, such as "comprises", "comprising"), "have" (and other forms of have, such as "has", "having"), "include" (and other forms of include, such as "includes" and "including"), and "contain" (and other forms of contain, such as "contains", "containing") are understood to be open-ended linking verbs. As a result, a method or apparatus that "comprises," "has," "includes," or "contains" one or more steps or elements may possess those one or more steps or elements, but is not limited to possessing only those one or more steps or elements. Similarly, a method step or apparatus element that "comprises," "has," "includes," or "contains" one or more features may possess those one or more features, but is not limited to possessing only those one or more features. Furthermore, an apparatus or structure that is configured in a certain way may be configured in a way that is not recited, although it is configured in at least that way.

The present invention has been described with reference to preferred embodiments. It is understood that the operational embodiments described herein are illustrative of multiple possible arrangements for providing the same general features, characteristics, and general system operation. Other modifications and alterations may occur upon reading and understanding the foregoing detailed description. It is intended that the invention be construed as including all such modifications and alterations.

Claims (36)

A guide arm;
a guide tube coupled to the guide arm;
a guide pin movably engaged with an end of the guide arm;
The guide arm is
a body extending between a first end and a second end;
an engagement portion engaged with the first end of the body;
Equipped with
The engagement portion has a through hole extending along a longitudinal direction of the guide arm and a screw extending through the through hole,
The guide tube is
a threaded portion that engages with the thread of the guide arm ;
a body coupled to a first end of the threaded portion and extending away from the threaded portion;
a head coupled to a second end of the threaded portion;
a throughbore extending through the head, the threaded portion, and the body of the guide tube along a length of the guide tube. The guide arm is
a sloped portion extending downward from the body of the guide arm toward the second end of the guide arm;
2. The targeting guide assembly of claim 1 , further comprising: a widened portion disposed at a first end of the guide arm and extending perpendicularly from a body of the guide arm. The targeting guide assembly of claim 2 , wherein the through hole of the widened portion receives the guide tube. The second end of the guide arm
a housing element disposed at an end of the inclined portion opposite the body of the guide arm;
a first projection extending away from the housing element on a first side;
and a second projection extending away from the housing element on a second side. The housing element comprises:
An upper opening;
The targeting guide assembly of claim 4 comprising: a bottom opening; and an interior cavity formed between said bottom opening and said top opening. The targeting guide assembly of claim 5 , wherein the internal cavity has a spherical shape that receives a corresponding sphere of the guide pin. The targeting guide assembly of claim 5 , wherein the housing element further comprises a channel extending from an exterior surface of the housing element into the interior cavity. A drill guide that is inserted into a through hole of the guide tube;
A protective member that is inserted into a through hole of the drill guide;
a target pin having a first end and a second end, the target pin being received within the through hole of the protective member;
The targeting guide assembly of claim 5 , further comprising: a screw-like member inserted into the through hole of the guide tube. The protective member is
A cylindrical portion;
a knob disposed at an end of the cylindrical portion of the protective member;
The targeting guide assembly of claim 8 , wherein the protective member has a through hole extending through a cylindrical portion of the protective member and the protective member knob extends along a longitudinal direction of the protective member. The drill guide comprises:
A cylindrical portion;
a knob disposed at an end of the cylindrical portion of the drill guide;
The targeting guide assembly of claim 9 , wherein the drill guide bore extends through a cylindrical portion of the drill guide and the drill guide knob extends along a longitudinal axis of the drill guide. The screw-shaped member is
a head portion disposed at a first end of the threaded member;
at least one cutting flute disposed on a second end of the threaded member;
a cannula opening extending through said threaded member along a longitudinal axis;
The targeting guide assembly of claim 10 , comprising: a thread disposed along at least a portion of an exterior surface of the threaded member. The guide pin is
a shaft having a first end and a second end;
a spherical member coupled to the shaft of the guide pin between a first end and a second end of the shaft and inserted within the interior cavity of the housing element;
and a tip disposed on a second end of the shaft of the guide pin. The targeting guide assembly of claim 12 , wherein the tip of the guide pin is threaded. The targeting guide assembly of claim 12 , wherein the guide pin comprises a cylindrical protrusion adjacent the spherical member and disposed between the spherical member and the tip of the guide pin. The targeting guide assembly of claim 14 , further comprising a holder slidably coupled to the body of the guide arm. The holder includes:
a housing having a top surface and a bottom surface;
a knob rotatably coupled to the housing;
and a locking member extending through an opening in the housing . The holder includes:
a mounting arm extending parallel to the housing, away from the bottom surface of the housing, toward the top surface of the housing;
17. The targeting guide assembly of claim 16 , comprising: a channel formed between the housing and the mounting arm. The targeting guide assembly of claim 17 , wherein the housing and the mounting arm form a U-shaped structure. The targeting guide assembly of claim 17 , wherein the mounting arm includes at least one opening extending from an exterior surface through the mounting arm to a channel in the holder. The targeting guide assembly of claim 19 , wherein an engagement protrusion of a knob of the holder is inserted into the at least one aperture of the mounting arm to couple the holder to a body of the guide arm. The targeting guide assembly of claim 20 , wherein the engagement protrusion is threaded. The targeting guide assembly of claim 20 , wherein the housing further comprises an alignment post extending away from the bottom surface of the housing adjacent the opening in the housing for receiving the locking member. The locking member is
a shaft engaging the opening in the housing;
a knob disposed on a first end of the shaft of the locking member;
23. The targeting guide assembly of claim 22 , further comprising: an engagement portion disposed on a second end of the shaft of the locking member for coupling with a bone plate. The targeting guide assembly of claim 23 , wherein the engagement portion is threaded. The bone plate comprises:
a bone engaging surface opposite the exterior surface;
and an engagement aperture that receives the engagement portion of the locking member of the holder to couple the targeting guide assembly to the bone plate. 26. The targeting guide assembly of claim 25 , wherein the bone plate further comprises a plurality of apertures extending from the exterior surface to the bone engaging surface and configured to receive a plurality of bone fasteners. the first projection includes a first through hole extending through the first projection from the top to the bottom of the housing element;
The targeting guide assembly of claim 4 , wherein the second projection includes a second through hole extending through the second projection from the top to the bottom of the housing element. a first fixation wire received within the first through hole;
28. The targeting guide assembly of claim 27 , further comprising: a second anchoring wire received within the second throughbore. the first through hole is angled such that the first through hole extends from the top to the bottom of the housing element;
28. The targeting guide assembly of claim 27 , wherein the second through hole is angled such that the second through hole extends from the top toward the bottom of the housing element. The head of the guide tube has a first diameter;
the threaded portion has a second diameter;
The targeting guide assembly of claim 1 , wherein the first diameter is greater than the second diameter. The head of the guide tube is
at least one notch circumferentially disposed about an exterior surface of the head of the guide tube;
a recessed opening extending into the head of the guide tube and surrounding the throughbore of the guide tube. 32. The targeting guide assembly of claim 31 , further comprising a tool having an engagement tab that engages the at least one notch in the head of the guide tube. a drill guide inserted into a through hole of the guide tube;
a protective member inserted through a through hole of the drill guide;
a target pin having a first end and a second end and received within the through hole of the protective member;
33. The targeting guide assembly of claim 32 , further comprising: a threaded member inserted through the through hole of the guide tube. 34. The targeting guide assembly of claim 33 , wherein the head of the drill guide engages the recessed opening in the head of the guide tube. a compression cap;
The compression cap comprises:
A base and
a plurality of tabs extending away from the second end of the base;
a plurality of grooves disposed between each of the plurality of tabs;
a through hole extending through said base and through said plurality of tabs;
a plurality of teeth, each of the plurality of tabs including a tooth extending away from an inner surface of each of the other portions into the throughbore of the compression cap;
35. The targeting guide assembly of claim 34 , wherein the tines of the tabs engage a lip disposed at a proximal end of the guide tube. 36. The targeting guide assembly of claim 35 , wherein the compression cap further comprises a slot extending through the compression cap from the top surface to the bottom surface and from an exterior surface to the through hole of the compression cap.

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